NCG060026 DMR SW (2)

CERTIFIC
FACILITY
COUNTY
PERSON
LABORAI
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division pf Water QualA't G neral Permit No. NCG060000
Date submitted '+ — � t — I
Part A: Stormwater Benchmarks and Monitorine Results
RECEIVED
MAY 0 6'N15
//�� j C�IvTb.L FILES
SAMPLE COLLECTION YEAR--- X101 s DWR SECTION
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats Bluse animal fats/byproducts
DISCHARGING TO SALTWATERS? MYES P10
PLEASE'REMEMBER TO SIGN ON THE REVERSE 4
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3The total precipitation must be recorded using data from an on-site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor all per month? ❑ yes no (if yes • complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging, > S5 gal of new motor oil/month.
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only oNNnca LU 10L.nILICS uldL use/process meals.
3The total precipitation must be recorded using data from an on-site rain gauge.
s For sampling periods with no discharge at anv outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SVM -249
Last Revised: October 18. 2012

*FOR PART A AND PART B MONITORING RESULTS:
•, A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTIO.
® TIER & HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an ori final and one copy of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the la&results for at end of
monitorina period in the case of "No Discharae" reoortsl to:
Division of Water Quality
Attn: DWQ Central Files
16V,Mail Service Center
Raleigh, NC 27699-161
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
`k -a$ -1s
(Date)
Additional copies of this form may be downloaded at: htttp://Portal.ncdenr.ors/web/wa/ws/su/npdessw#tab-4
SWM -249
Last Revised: October 18, 2012
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